A comparison of the efficacy of various metipranolol-pilocarpine combinations in patients with ocular hypertension and primary open-angle glaucoma.

We compared the ocular hypotensive effects of four fixed-dose metipranolol-pilocarpine combinations in nineteen ocular hypertensive subjects and glaucoma patients. Each patient was tested with all of the study medications: vehicle alone, 0.1% metipranolol HCl + 2% pilocarpine HCl, 0.1% metipranolol HCl + 4% pilocarpine HCl, 0.3% metipranolol HCl + 2% pilocarpine HCl, and 0.3% metipranolol HCl + 4% pilocarpine HCl, in a single dose, randomized, double-masked, cross-over placebo-controlled trial. In addition, another eight age and baseline intraocular pressure (IOP)-matched subjects received 0.1% or 0.3% metipranolol HCl, while a similar group of 14 volunteers received 2% or 4% pilocarpine HCl. A two week washout period was instituted between the various groups of treatments. All four metipranolol-pilocarpine combinations were more effective than placebo or either medication alone in reducing the average IOP for up to 8 hours (p < 0.05 for each treatment group). Metipranolol HCl 0.3%, regardless of the pilocarpine concentration, demonstrated the most significant IOP lowering effect, reducing the IOP by 4.9 mm Hg or about 20% from baseline. However, 0.1% metipranolol HCl in combination with 4% pilocarpine HCl was found almost as effective with a 18.5% reduction in IOP from baseline, but a shorter duration of action. In conclusion, all metipranolol-pilocarpine combinations were more efficacious than either medication alone in a single-dose trial. Additional multiple-dose studies are needed to determine the long-term effectiveness and tolerance of combining 0.3% metipranolol HCl with either 2% or 4% pilocarpine HCl.

Tonometry comparison: Goldmann versus Tono-Pen.

Tono-Pen and Goldmann tonometers were compared in 152 eyes of healthy subjects (Group A) and 69 eyes of patients after intraocular procedures (Group B). In Group A, the readings from both the tonometers showed no statistically significant difference in the 0 to 15mmHg range. However, the Tono-Pen values were lower in eyes with intraocular pressures between 16 and 30mmHg (P less than .0001). This questions the reliability of Tono-Pen as an adequate screening instrument. The correlation between the two instruments was acceptable in Group B (r = .89), indicating that the Tono-Pen may be used cautiously to determine intraocular pressure in postoperative patients.

Intraocular pressure following ECCE, phacoemulsification, and PC-IOL implantation.

Abnormal intraocular pressure (IOP), either transient or permanent, may follow extracapsular cataract extraction (ECCE) with phacoemulsification (PE) and posterior chamber intraocular lens (PC-IOL) implantation. We retrospectively studied IOP measurements at different intervals post ECCE and PE in 242 eyes of 211 patients: 105 males, 106 females, 198 Caucasians and 13 blacks. Elevated IOP (greater than 23 mm Hg) was observed in 20 eyes (8.2%). Only two patients (0.8%) had persistent (greater than 3 months) IOP elevation and needed antiglaucoma therapy. Six more eyes (2.5%), however, developed glaucoma after 1 year. Hence, the incidence of secondary pseudophakic glaucoma at the conclusion of this study was 3.3%. No patient required laser or other mechanical surgery for IOP control. ECCE and PE with PC-IOL does not appear to adversely affect IOP. Patients, however, must be followed closely, as some may develop glaucoma months after surgery.

Intraocular pressure following ECCE and IOL implantation in patients with glaucoma.

Patients with glaucoma may suffer optic nerve head damage due to elevated intraocular pressure (IOP) after any intraocular procedure. We retrospectively reviewed the IOP data in 82 consecutive patients (103 eyes) with glaucoma after extracapsular cataract extraction (ECCE) and posterior chamber intraocular lens (PC-IOL) implantation. Nine eyes had previous trabeculectomy and three eyes required combined trabeculectomy with ECCE and PC-IOL. The average follow-up period is 1.5 years (range 0.5 to 6 years). The postoperative IOP rise of 8 mm Hg over baseline or above 23 mm Hg was observed in 45 eyes (49.5%). Two eyes needed argon laser trabeculoplasty and one required trabeculectomy to control postoperative IOP elevation. Most of the patients required the same or lesser number of medications for IOP control after surgery. Results suggest that ECCE with PC-IOL may be a relatively safe procedure in cataract patients with preexisting glaucoma.

Intraocular pressure following extracapsular cataract extraction and posterior chamber intraocular lens implantation.

Knowledge of the incidence of both short- and long-term elevation of intraocular pressure (IOP) after extracapsular cataract extraction (ECCE) and posterior chamber intraocular lens (PC-IOL) insertion is essential for the practicing ophthalmologist. We reviewed retrospectively the IOP data in 384 consecutive patients (506 eyes) that underwent the above procedure. A postoperative rise of 8 mm Hg above baseline or above 23 mm Hg was observed in 149 eyes (29%). Secondary glaucoma well controlled medically developed in 21 eyes (4%). Three eyes developed glaucoma after the first year postoperatively. Therefore, over the total follow-up period of 6 years, 24 eyes (4.7%) developed pseudophakic glaucoma. None, however, required laser or other surgical intervention. These results further support the prevailing view that ECCE with PC-IOL is the procedure of choice.

Intraocular pressure following secondary anterior chamber lens implantation.

Secondary anterior chamber implantation has become relatively simple since the advent of viscoelastic materials. Still, glaucoma, cystoid macular edema, endophthalmitis, and astigmatism remain vision-threatening complications. We studied intraocular pressures (IOPs) following this surgery in 102 patients (124 eyes) over 6 years. Elevated IOP was noted in 32 eyes (25.8%), but only 14 (11.3%) needed long-term medical treatment. None, however, required laser iridectomy, trabeculoplasty, or trabeculectomy. Patients should be selected for secondary anterior chamber implantation only after more conservative measures have been exhausted.

Trabeculectomy vs. nonpenetrating trabeculectomy: a retrospective study of two procedures in phakic patients with glaucoma.

In a retrospective study we compared the efficacy and safety of trabeculectomy and nonpenetrating trabeculectomy (NPT). In the latter procedure under a thin scleral flap, juxtacanalicular trabecular meshwork with Schlemm's canal is excised leaving the innermost trabecular meshwork behind. Trabeculectomy was performed on 86 eyes (66 blacks, 20 whites), whereas 71 eyes underwent NPT (44 blacks, 27 whites). The mean follow-up period was 1.7 years. Postoperatively at one year, trabeculectomy controlled 70.3% of patients with no or topical antiglaucoma medication, whereas 83.7% of NPT patients were similarly controlled. There was a difference in the number and severity of complications between trabeculectomy and NPT. Postoperative flat anterior chamber, uveitis, hyphema, vitreous loss, and choroidal detachment occurred more frequently after trabeculectomy.